SISC Flex Plan
HEALTH CARE AND DEPENDENT CARE EXPENSES
*Please note, all "potentially eligible expenses" require a Certification of Medical Necessity form completed by your medical
practitioner in order to be considered eligible for reimbursement. The letter must include 1. Medical condition/diagnosis 2.
Specific recommended treatment 3. Duration of treatment. This letter must be submitted with every claim.
Reminder: The SISC Flex Card will not work to purchase any Over-The Counter items.
Account
Type
Eligible
Expense
ABORTION
HCFSA
X
ACNE TREATMENT
HCFSA
ACUPUNCTURE
HCFSA
ADAPTIVE EQUIPMENT
HCFSA
Condition/Type of Service/Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
A
X
Acne is considered a disease, the cost of acne treatment will
generally qualify (including over-the counter (OTC) acne
medications). However, the cost of routine skin care (face
creams, moisturizers, etc.) does not qualify and when the
expense has both medical and cosmetic purposes a
Certification of Medical necessity is required.
X
Adaptive equipment for a major disability, such as a spinal
cord injury, may be reimbursed.
X
Adaptive equipment to assist you with activities of daily living
(ADL) for persons with arthritis, lupus, fibromyalgia, etc., may
be reimbursed.
OTC
ADOPTION: FEES
HCFSA
ADOPTION: PRE-ADOPTION MEDICAL
EXPENSES
HCFSA
AIR CONDITIONERS
X
X
Medical expenses incurred before an adoption is finalized may
qualify, if the child qualifies as your tax dependent when the
services/items are provided.
HCFSA
X
See CAPITAL EXPENSES for important information and
guidance.
HCFSA
X
See ALLERGY PRODUCTS
OTC
AIR PURIFIERS
OTC
ALCOHOLISM/DRUG/SUBSTANCE
ABUSE TREATMENT
Adoption fees and other non-medical expenses incurred in
connection with adoption assistance may qualify for an
adoption assistance credit (under Code 23) or for
reimbursement under an adoption assistance program (under
Code 137).
HCFSA
X
Inpatient treatment, including meals and lodging provided by
a licensed addiction center.
Outpatient care
Transportation expenses associated with attending outpatient
meetings, including AA groups, if attending on a doctor’s
advice.
ALLERGY MEDICINES
HCFSA
X
Examples: Actifed, Alavert, Allerest, Benadryl, ChlorTrimentron, Claritin, Sudafed
HCFSA
X
Expenses generally won't qualify if the product would be
owned even without allergies, such as a pillow or a vacuum
cleaner. However, an air purifier or water filter necessary to
treat a specific medical condition might qualify. The excess
cost of a special version of an otherwise personal item (e.g., a
vacuum cleaner with a HEPA filter) over the normal cost of the
item might also qualify if the special version of the item is
necessary to treat a specific medical condition.
OTC
ALLERGY PRODUCTS
OTC
ALTERNATIVE HEALERS
HCFSA
ALTERNATIVE HEALER
RECOMMENDED DIETARY
SUBSTITUTES, MEDICINES
HCFSA
X
Alternative healers who provide care for the treatment of a
specific illness or disorder for you, your spouse or dependent
may be reimbursed under a HCFSA.
X
Non-traditional healing treatments provided by professionals
may be eligible if provided to treat a specific medical
condition. The treatments must be legal, and the expenses do
not qualify if the remedy is a food or substitute for food that
the person would normally consume. Drugs and medicines
recommended by alternative healers to treat a specific
medical condition may also qualify as medical care.
Condition/Type of Service/Expense
AMBULANCE
ANALGESICS
ANTACIDS
ANTIBIOTIC OINTMENTS
ANTICANDIALS
ANTIDIARRHEA AND LAXATIVES
ANTIFUNGALS
ANTIHISTAMINES
OTC
OTC
OTC
OTC
OTC
OTC
OTC
ANTI-ITCH CREAMS
Account
Type
Eligible
Expense
HCFSA
X
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
HCFSA
X
Examples: Aspirin, Advil, Alleve, Bayer, Ibuprofen, Naprosyn,
Tylenol, Midol, Pamprin
HCFSA
X
Examples: Gas-X, Maalox, Mylanta, Tums, PepcidAC, Prilosec
OTC, TagamentHB, Zantac
HCFSA
X
Examples: Bacitrain, Triple antibiotic ointment, Neosporin
HCFSA
X
Examples: Femstat 3, Gyne-Lotrimin, Mycelex-7, Monistat3,
Vagistat-1
HCFSA
X
Examples: Ex-Lax, Imodium AD, Kaopectate, Pepto-Bismol
HCFSA
X
Examples: Lamisil AT, Lotramin AF, Micatin
HCFSA
X
Examples: Actifed, Allerest, Benadryl, Claritin, ChlorTrimetron, Sudafed
HCFSA
X
Examples: Bactine, Benadryl, Caldecort, Caladryl, Calamine,
Cortaid, Hydrocortisone, Ivarest, Lanacort, Lamisil AT,
Lotramin AF
OTC
ARTIFICIAL LIMBS
HCFSA
X
ARTIFICIAL REPRODUCTIVE
TECHNOLOGIES
HCFSA
X
Eligible medical expenses may include (but are not limited
to):
Fertility exams;
Artificial insemination (intracervical, intrauterine,
intravaginal);
In-vitro/In-vivo fertilization;
Gift;
Sperm bank storage/fees for artificial insemination;
Sperm implants;
Sperm washing;
Reverse vasectomy;
Embryo replacement and storage;
Egg donor charges for recipient;
Embryo transfer.
NOTE: Storage fees should not exceed twelve months.
ARTIFICIAL TEETH
ASTHMA MEDICINES
AUTOMOBILE MODIFICATIONS
HCFSA
OTC
X
HCFSA
X
Examples: Bronitin Mist, Bronkaid, Bronkolixer, Primatene
HCFSA
X
If for physically handicapped persons. Expenses of operating a
specially equipped car do not qualify.
See ADAPTIVE EQUIPMENT, See CAPITAL EXPENSE, and See
TRANSPORTATION
Potentially
Eligible
Expense*
Account
Type
Eligible
Expense
HCFSA
X
Examples: Band-Aid or Curad without medication may be
eligible. Medicated items would require a Certification of
Medical Necessity form.
HCFSA
X
Ace bandages, wraps
BEDSIDE COMMODES
HCFSA
X
BEFORE AND AFTER-SCHOOL CARE
DCFSA
X
Child must be under age 13 or one who is incapable of selfcare and can be claimed on your Federal Income Tax return.
BIRTH CONTROL
HCFSA
X
Birth Control Pills, Norplant
Condition/Type of Service/Expense
Not
Eligible
Additional Information
B
BAND-AIDS
OTC
BANDAGES
OTC
HCFSA
X
Condoms with spermicide would require a Certification of
Medical Necessity form. Condoms without spermicide may be
eligible.
OTC
BLOOD PRESSURE MONITORS
OTC
BLOOD STORAGE
BLOOD SUGAR TEST KIT AND TEST
STRIPS
HCFSA
X
HCFSA
They are diagnostic items.
X
Blood storage is an eligible expense if you are storing blood
for a scheduled surgery. Fees for indefinite storage, just in
case the blood might be needed, would not be considered
medical care.
HCFSA
X
They are diagnostic items.
BODY SCANS
HCFSA
X
They are diagnostic services.
BOUTIQUE PRACTICE FEES
HCFSA
BRAILLE BOOKS AND MAGAZINES
HCFSA
X
The incremental cost of Braille books and magazines that
exceeds the price for regular books and magazines is an
eligible expense if for a visually impaired person.
HCFSA
X
Breast pumps and other supplies that assist lactation will
qualify.
HCFSA
X
Eligible to the extent that surgery was done following a
mastectomy for cancer. This is an exception to the general
rules regarding cosmetic procedures.
OTC
BREAST PUMPS
X
OTC
BREAST RECONSTRUCTION SURGERY
FOLLOWING MASTECTOMY
Monthly or annual fees that your provider may charge for
improved access, 24/7 availability and more “personalized”
care are not considered medical care and cannot be
reimbursed under a health care FSA.
C
CALAMINE LOTION
CAMPS, summer or holiday (Day)
OTC
HCFSA
DCFSA
X
X
This includes children under age 13, or any individual who is
incapable of self-care and can be claimed on your Federal Tax
return.
Payment in advance is not covered. You can only be
reimbursed for expenses that have been incurred.
CAMPS, summer or holiday
(Overnight)
DCFSA
X
Condition/Type of Service/Expense
CAPITAL EXPENSE
Account
Type
Eligible
Expense
HCFSA
Potentially
Eligible
Expense*
X
Not
Eligible
Additional Information
A capital expense may be reimbursed if its purpose is to
provide medical care for you, your spouse or dependent.
Expenses for improvements or special equipment added to
your home may be reimbursed if the primary purpose of the
expenditure is medical care for you, your spouse, or
dependent and the expenditure would not be incurred "but for
this purpose". How much is reimbursed depends on the extent
to which the expense permanently improves the property and
whether others benefit.
If the improvement is permanent and increases the value of
the proper, the expense will qualify only to the extent that the
improvement cost exceeds the increase in property value. If
the improvement doesn't increase the property value at all,
then the entire cost may qualify. Items that usually don't
increase peroperty value include constructing entrance or exit
ramps, widening or modifying doorways or hallways, installing
railing or support bars to bathrooms, lowering or modifying
kitchen cabinets or equipment, moving or modifying electrical
outlets and fixtures, installing porch lifts, modifying electrical
outlets and fixtures, installing porch lifts, modifying fire
alarms or smoke detectors, modifying other warning systems,
and modifying stairways.
CARPAL TUNNEL WRIST SUPPORTS
HCFSA
X
See Bandages
CHILDBIRTH CLASSES
HCFSA
X
Expenses may qualify to the extent that instruction relates to
birth and not childrearing. The fee should be apportioned to
exclude instruction in topics such as newborn care. Expenses
for the coach do not qualify.
CHIROPRACTIC
HCFSA
X
CHONDROITIN
OTC
OTC
HCFSA
X
If used primarily for medical care.
CHRISTIAN SCIENCE PRACTITIONERS
HCFSA
X
Payments for medical care may be reimbursed. Fees for other
purposes do not qualify.
CIRCUMCISION
HCFSA
X
COBRA PREMIUMS
HCFSA
CO-INSURANCE
HCFSA
COLD, FLU, DECONGESTANT & SINUS
REMEDIES
HCFSA
X
Examples: Actifed, Advil Cold & Sinus, Afrin, Alka Seltzer Cold
& Flu, Alleve Cold & Sinus, Contac, Dayquil, Dimetane, Dristan
Long-Lasting, Neo-Synephrine, Nyquil, Sudafed, Thera-Flu,
Triaminic, Cough Drops, Nasal Sprays, Throat Lozenges
HCFSA
X
Example: Abreva Cream
X
X
Under IRS rules, insurance premiums cannot be reimbursed
under a health care FSA.
Cannot be reimbursable by secondary insurance or any other
source.
OTC
COLD SORE/FEVER BLISTER
MEDICATIONS
COLD/HOT PACKS
OTC
OTC
HCFSA
COMPANION ANIMALS
HCFSA
COMPRESSION HOSE
HCFSA
CONTACT LENSES, MATERIALS, AND
EQUIPMENT
HCFSA
OTC
X
Must be used to alleviate a specific medical condition.
See SERVICE ANIMALS
X
X
Won't qualify if used for personal or preventive reasons. If
used to treat or alleviate a specific medical condition, only the
excess cost of the specialized hose over the cost of regular
hose may qualify.
Lenses must be for medical purposes. Materials examples:
Saline Solution and Enzyme Cleaner
Condition/Type of Service/Expense
CONTRACEPTIVES
OTC
Account
Type
Eligible
Expense
HCFSA
CONTROLLED SUBSTANCES
HCFSA
CO-PAYMENTS
HCFSA
CORD BLOOD STORAGE
HCFSA
COSMETIC PROCEDURES
HCFSA
Potentially
Eligible
Expense*
X
Not
Eligible
See BIRTH CONTROL
X
X
Cannot be reimbursable by secondary insurance or any other
source.
X
Can be reimbursed if there is a specific medical condition that
the cord blood is intended to treat. Indefinite storage “just in
case” is not an eligible expense.
X
X
COSMETIC PRODUCTS
HCFSA
OTC
X
HCFSA
CPAP (continuos positive airway
pressure)devices
HCFSA
COUNSELING
HCFSA
Most cosmetic procedures do not qualify.
A cosmetic procedure or service necessary to improve a
deformity arising from a congenital abnormality, personal
injury from accident or trauma, or disfiguring disease may
qualify.
OTC
COUGH SUPPRESSANTS
Additional Information
Examples: Body Sprays, Cologne, Creams, Deodorants, Hair
Removal, Lipsticks, Lotion, Make-up, Perfumes, Shampoo,
Shaving Cream, Skin Moisturizers, Soaps, Toothbrush,
Toothpaste
X
Examples: Pediacare, Robitussin, cough drops, Vicks 44,
Chloraseptic
X
May be eligible if counseling is provided for medical care and
not just for the general improvement of mental health, relief
of stress, or personal enjoyment.
X
Eligible expenses may include: bereavement counseling, grief
counseling, psychotherapy, psychologist, and sex counseling
X
CRUTCHES
OTC
HCFSA
X
DCFSA
X
Life coaching, career counseling, marriage counseling, and
parenting skill counseling do not qualify.
D
DAYCARE
This includes daycare as well as in-home babysitters for
children under age 13, or any individual who is incapable of
self-care and can be claimed on your Federal Tax return.
Payment in advance is not covered. You can only be
reimbursed for expenses that have been incurred.
DANCING LESSONS
DECONGESTANTS
OTC
DEHYDRATION
HCFSA
X
Only for a short duration and if prescribed for a specific
medical condition, such as part of a rehabilitation program
after surgery, and the expense would not have been incurred
but for the condition.
HCFSA
X
Examples: Dimetapp, Sudafed
HCFSA
X
Examples: Pedialyte, Enfalyte
OTC
DEDUCTIBLES
HCFSA
X
Cannot be reimbursable by secondary insurance or any other
source.
Condition/Type of Service/Expense
DENTAL CARE
Account
Type
Eligible
Expense
HCFSA
X
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
Covered services may include, but are not limited to:
Bridges;
Cleanings;
Crowns;
Dental implants;
Dentures & denture adhesives;
Endodontic care (root canal);
Extractions;
Fillings;
Orthodontia;
Periodontal services;
Routine prophylaxis;
Sealants;
X-rays.
HCFSA
DENTAL CARE
OTC
DENTAL PRODUCTS
HCFSA
Expenses for cosmetic dentistry, such as teeth whitening or
bleaching, veneers, or bonding are not eligible for
reimbursement.
Anbesol, orajel
X
Examples: Dental floss, Toothpaste, Toothbrushes, Teeth
whitening kits
X
HCFSA
DIABETIC SUPPLIES
X
HCFSA
X
Examples: Blood sugar test kits and strips, Glucose
monitoring equipment, Insulin
HCFSA
X
Procedures to determine the presence of a disease or
dysfunction of the body, such as tests to detect heart attack,
stroke, diabetes, osteoporosis, thyroid conditions, and cancer.
Medical monitoring and testing devices.
OTC
DIAGNOSTIC ITEMS/SERVICES
DIAPER RASH CREAMS
OTC
DIAPERS, DIAPER SERVICE
HCFSA
X
HCFSA
HCFSA
Examples: Desitin, Balmax, Aveeno Baby
X
X
Routine care of healthy newborn.
To relieve or ameliorate the effect of a particular illness or
disease on you, your disabled child or dependent, who would
not need this product “but for” the medical condition.
OTC
DIARRHEA MEDICINE
OTC
DIETARY SUPPLEMENTS
HCFSA
X
Examples: Imodium, Kaopectate
HCFSA
X
Dietary supplements, nutritional supplements, vitamins,
herbal supplements, and natural medicines may qualify if they
are recommended by a medical practitioner to treat a specific
medical condition.
OTC
DIET FOODS
DOCTOR FEES
OTC
HCFSA
HCFSA
X
X
In addition to all expenses for care not reimbursed by any
other source, eligible expenses may include fees for:
Out-of-network providers;
Charges by your physician for letters of medical necessity to
schools;
Physician tele-advice, including email communication.
DRUG ADDICTION, treatment of
HCFSA
X
Eligible expenses may include:
Inpatient treatment, including meals and lodging provided by
a licensed addiction center;
Outpatient care;
Transportation expenses associated with attending outpatient
meetings, including AA groups, if attending on a doctor’s
advice.
Potentially
Eligible
Expense*
Account
Type
Eligible
Expense
DRUG OVERDOSE, treatment of
HCFSA
X
DRUGS AND MEDICINES THAT MAY BE
PURCHASED ONLY BY PRESCRIPTION
HCFSA
X
DRUGS AND MEDICINES THAT ARE
AVAILABLE FOR PURCHASE WITHOUT
A PRESCRIPTION (OVER-THECOUNTER(OTC)DRUGS OR
MEDICINES)
HCFSA
X
Must be used to treat a specific medical condition.
HCFSA
X
See LANGUAGE TRAINING
HCFSA
X
Examples: Debrox, Murine
HCFSA
X
Must be prescribed to treat a specific medical condition, such
as the presence of middle/inner ear tubes.
EDUCATION
DCFSA
X
Payments made to a special school for a mentally impaired or
physically disabled person may qualify as reimbursable if the
main reason for using the school is its resources for relieving
the disability. This includes teaching Braille to a visually
impaired person, teaching lip reading to a hearing impaired
person, and giving remedial language training to correct a
condition caused by a birth defect.
EGG DONOR FEES
HCFSA
EGGS AND EMBRYOS, STORAGE FEES
HCFSA
ELDER CARE
DCFSA
ELECTROLYSIS OR HAIR REMOVAL
HCFSA
ELEVATOR
HCFSA
Condition/Type of Service/Expense
Not
Eligible
Additional Information
Must be used to treat a medical condition and not for
personal, general health, or cosmetic purposes. Drugs that are
illegally procured do not qualify. Note: Dual purpose items
that include a medical and cosmetic purpose may require a
certification of medical necessity form.
OTC
DYSLEXIA
E
EAR DROPS AND WAX REMOVAL
PRODUCTS
OTC
EAR PLUGS
OTC
X
Amounts paid for the egg donor fee, an agency fee, an egg
donor's medical and psychological testing, and the legal fees
for preparation of the egg donor contract may qualify.
Fees for temporary storage may qualify, but only to the extent
necessary for immediate conception. Storage fees for
undefined future conception probably aren't considered
medical care.
X
X
Adult must live with you at least 8 hours a day and be claimed
as a dependent on your Federal Tax return.
X
X
See COSMETIC PROCEDURES
Installing an elevator upon the advice of a physician so that a
person with a heart disease won't have to climb stairs may be
medical care to the extent of the amount in excess of value
enhancement of the property.
See CAPITAL EXPENSES for important information and
guidance.
EXERCISE EQUIPMENT OR PROGRAMS
HCFSA
X
See FITNESS PROGRAMS
OTC
EYE CARE
HCFSA
X
Example: Contact lens supplies, Eye patches, and
unmedicated eye drops may be eligible. Medicated items
would require a Certification of Medical Necessity form.
HCFSA
X
Includes prescription sunglasses and reading glasses (even
those purchased over-the-counter).
OTC
EYE EXAMINATIONS, EYEGLASSES,
EQUIPMENT AND MATERIALS
Eligible only if required to treat an illness (such as obesity)
diagnosed by a physician.
Condition/Type of Service/Expense
Account
Type
Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
F
FACE CREAMS AND MOISTURIZERS
OTC
HCFSA
X
Generally no. Considered cosmetic.
See COSMETIC PRODUCTS
FAMILY PLANNING
HCFSA
FEMININE HYGIENE PRODUCTS
HCFSA
X
Includes ovulation predictor kits and pregnancy tests.
X
OTC
FIBER SUPPLEMENTS
HCFSA
X
Only if used to treat a diagnosed medical condition (such as
irritable bowel syndrome) until the condition is alleviated.
Examples: Benefiber, Metamucil
OTC
FINANCE CHARGES
HCFSA
FIRST AID/MEDICAL SUPPLIES
HCFSA
X
X
Unmedicated Bandages, First aid kits, Cold/hot packs for
injuries, Joint supports, Ace wraps, Splints, Thermometers
OTC
FIRST AID/MEDICAL SUPPLIES
HCFSA
X
First aid creams, Antiseptics, Medicated Bandages, Liquid
adhesives
HCFSA
X
Fees paid for a fitness program may be an eligible expense if
prescribed by a physician and substantiated by his or her
statement that treatment is necessary to alleviate a medical
problem. The purpose of the expense must be to treat the
disease rather than to promote general health.
OTC
FITNESS PROGRAMS
Generally no, since these are ordinarily considered as being
used to maintain general health. There may be exceptions
(e.g. if a medical practitioner recommends the product to
alleviate a specific condition).
See EXERCISE EQUIPMENT or PROGRAMS
FLU SHOTS
HCFSA
X
FLUORIDATION DEVICE OR SERVICES
HCFSA
X
Must be recommended by a dentist to prevent tooth decay.
The amount that qualifies is limited to the cost allocable to the
current year.
OTC
FOOD
HCFSA
X
See SPECIAL FOODS
OTC
FOOT CARE
HCFSA
x
All products must be unmedicated: Callous removers,
Athlete's foot products, Bunion, Blister & Corn treatments may
be eligible. Medicated items would require a Certification of
Medical Necessity form.
OTC
FUNERAL EXPENSES
HCFSA
X
G
GENETIC TESTING
GLUCOSAMINE
GLUCOSE MONITORING EQUIPMENT
OTC
OTC
GUIDE DOGS: OTHER SERVICE
ANIMALS
HCFSA
X
To the extent that testing is done to diagnose a medical
condition or determine possible defects.
HCFSA
X
If used primarily for medical care. Example: Chondroitin
HCFSA
X
They are diagnostic items.
HCFSA
X
Expenses for buying, training, and maintaining a service
animal used by a physically disabled person may qualify.
See VETERINARY FEES
H
HAIR REMOVAL AND TRANSPLANT
HEADACHE MEDICATIONS
HEALTH SCREENINGS
HCFSA
OTC
X
HCFSA
HCFSA
X
X
Generally cosmetic
Examples: Advil, Aspirin, Tylenol
See PREVENTIVE CARE SCREENINGS
Condition/Type of Service/Expense
HEARING AIDS
Account
Type
Eligible
Expense
HCFSA
X
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
Includes batteries
OTC
HEMORRHOID PREPARATIONS
OTC
HERBS
HCFSA
X
Examples: Preparation H, Tronolane, Tucks
HCFSA
X
If they are recommended by a medical practitioner to treat a
specific medical condition.
OTC
HOME DIAGNOSTIC TESTS OR KITS
HCFSA
X
Examples: Blood pressure monitor and related equipment,
Cholesterol, Diabetic equipment and supplies, Colorectal
screenings, HIV test, Colonoscopy prep kits
OTC
HCFSA
HOME IMPROVEMENTS (SUCH AS
EXIT RAMPS, WIDENING DOORWAYS,
X
Only if done to accommodate a disability.
See CAPITAL EXPENSES for important information and
guidance.
HOME MEDICAL EQUIPMENT
HCFSA
X
See CAPITAL EXPENSES for important information and
guidance.
HOMEOPATHIC CARE
HCFSA
X
Homeopathic care rendered by a licensed health care
professional who provides this care for the treatment of a
specific illness or disorder for you, your spouse or dependent
may be reimbursed under a HCFSA.
HOMEOPATHIC MEDICINES
HCFSA
X
Homeopathic medicines used for treatment of a specific illness
or disorder may be reimbursed.
HORMONE REPLACEMENT THERAPY
HCFSA
X
If used primarily for medical care (for example, to treat
menopausal symptoms such as hot flashes, night sweats, etc.)
HOSPITAL SERVICES
HCFSA
HOUSEHOLD HELP
HCFSA
HOUSEHOLD HELP
DCFSA
HUMIDIFIERS
OTC
X
X
X
HCFSA
Duties must include caring for an eligible dependent.
X
See ALLERGY PRODUCTS, See CAPITAL EXPENSES
I
IMMUNIZATIONS
HCFSA
X
Includes those recommended for overseas travel.
HCFSA
X
If used to relieve the effects of a particular disease. Examples:
Depends, Poise
INFERTILITY TREATMENTS
HCFSA
X
INSULIN
HCFSA
X
INSURANCE PREMIUMS
MEDICAL/DENTAL/VISION
HCFSA
INCONTINENCE SUPPLIES
OTC
Also, equipment needed to inject the insulin, such as syringes
or insulin pumps, qualifies as a medical expense.
X
Under IRS rules, insurance premiums cannot be reimbursed
under a health care FSA.
L
LAB FEES
HCFSA
X
LACTATION CONSULTANT
HCFSA
X
Services rendered by a licensed health care provider may be
reimbursed.
LAMAZE CLASSES
HCFSA
X
Expenses may qualify to the extent that instruction relates to
birth and not childrearing. The fee should be apportioned to
exclude instruction in topics such as newborn care. Expenses
for the coach do not qualify.
Condition/Type of Service/Expense
Account
Type
LANGUAGE TRAINING
HCFSA
LASER EYE SURGERY: LASIK
HCFSA
Eligible
Expense
Potentially
Eligible
Expense*
X
Not
Eligible
Additional Information
If for a child with dyslexia or a disabled child. But school fees
for regular schooling normally don't qualify.
X
Eligible because the procedure is done primarily to promote
the correct function of the eye.
See VISION CARE
LATE PAYMENT FEES
DCFSA
X
HCFSA
X
LATE PICK-UP FEES
DCFSA
LAXATIVES
HCFSA
X
Examples: Ex-Lax
HCFSA
X
Expenses for removing lead-based paints from surfaces in
your home to prevent a child who has, has had, or is in
danger of lead poisoning from eating the paint may be
reimbursed. These surfaces must be in poor repair and within
a child’s reach.
LEAD-BASED PAINT REMOVAL
OTC
X
LEAD-BASED PAINT REMOVAL
(CONTINUED FROM PREVIOUS PAGE)
LEARNING DISABILITY,
INSTRUCTIONAL FEES
The cost of repainting the affected area(s) is not an eligible
expense. If you cover the area with wallboard or paneling
instead of removing the lead paint, these items will be treated
as capital expenses.
HCFSA
X
The portion of tuition/tutoring fees covering services rendered
specifically for your child's severe learning disabilities caused
by mental or physical impairments (such as nervous system
disorders, or closed head injuries) and paid to a special school
or to a specially-trained teacher may be reimbursed under a
HCFSA if prescribed by a physician. Examples of eligible
expenses may include:
Remedial reading for your child or dependent with dyslexia
Testing to diagnose
LEGAL FEES
HCFSA
X
Legal fees paid to authorize treatment for mental illness may
be eligible expenses.
LIFETIME CARE
HCFSA
LODGING AT A HOSPITAL OR SIMILAR
INSTITUTION
HCFSA
X
Provided the main reason for being there is to receive medical
care.
LODGING: NOT AT A HOSPITAL OR
SIMILAR INSTITUTION
HCFSA
X
Up to $50 per night may be eligible if the following conditions
are met:
X
Fees or advance payments made to a retirement home or
continuing care facility are not eligible expenses.
The lodging is primarily for, and essential to, medical care;
The medical care is provided by a doctor in a licensed hospital
or medical care facility related to/equivalent to a licensed
hospital;
The lodging is not lavish or extravagant;
There is no significant element of personal pleasure or leisure
in the travel.
LODGING OF A COMPANION
HCFSA
X
Your companion’s lodging may be reimbursed if he or she is
accompanying the patient (you or your eligible dependents)
for medical reasons and it meets the criteria listed above.
Meals are not eligible for reimbursement.
Example: Parents traveling with a sick child, up to $100 per
night ($50 per person) may be reimbursed.
Condition/Type of Service/Expense
Account
Type
Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
LODGING WHILE ATTENDING A
MEDICAL CONFERENCE
HCFSA
X
LONG-TERM CARE INSURANCE
PREMIUMS
HCFSA
X
Additional Information
Under IRS rules, insurance premiums cannot be reimbursed
under a HCFSA.
M
MASSAGE THERAPY
HCFSA
X
The costs of a massage just to improve general health doesn't
qualify. However, if the massage therapy was recommended
by a physician to treat a specific injury or trauma, then it
could qualify.
MATERNITY CLOTHES
HCFSA
MEALS AT A HOSPITAL OR SIMILAR
INSTITUTION
HCFSA
MEALS NOT AT A HOSPITAL OR
SIMILAR INSTITUTION
HCFSA
X
Meals that are not part of inpatient care do not qualify.
MEALS OF A COMPANION
HCFSA
X
Not eligible, even if accompanying a patient for medical
reasons.
MEDICAL ALERT BRACELET OR
NECKLACE
HCFSA
MEDICAL INFORMATION
HCFSA
X
Amounts paid to a plan that maintains electronic medical
information for you, your spouse or dependents may be
eligible for reimbursement under an HCFSA.
MEDICAL MONITORING AND TESTING
DEVICES
HCFSA
X
Examples: blood pressure monitors, syringes, glucose kit,
ovulation monitor pregnancy test kits
MEDICAL RECORDS CHARGES
HCFSA
X
Costs associated with copying or transferring medical records
to a new provider may be eligible for reimbursement.
MINERAL SUPPLEMENTS
HCFSA
X
X
If the main reason for being there is to receive medical care.
X
May qualify if recommended by a medical practitioner in
connection with treating a medical condition.
OTC
X
Must be used to treat a specific medical condition. Examples:
Calcium, Caltrate, Ferrous Sulfate, Folic Acid
OTC
MISSED APPOINTMENT FEES
MOTION SICKNESS PILLS
HCFSA
OTC
MOUTHWASH
X
HCFSA
X
HCFSA
Examples: Dramamine, Marizine
X
OTC
Generally not eligible, however a special mouthwash
recommended by a medical practitioner for the treatment of
gingivitis might qualify.
N
NASAL STRIPS OR SPRAYS
HCFSA
X
Nasal spray or strips that are used to treat sinus problems or
sleep apnea may qualify as medical care, but those used to
treat snoring, or by athletes would not qualify.
OTC
NATUROPATHIC CARE
HCFSA
NATUROPATHIC MEDICINES
HCFSA
NEWBORN NURSING CARE
HCFSA
X
Naturopathic care rendered by a professional who provides
this care for the treatment of a specific illness or disorder for
you, your spouse or dependent may be reimbursed under a
HCFSA.
X
Naturopathic medicines used for treatment of a specific illness
or disorder may be reimbursed.
X
Nursing services for a normal, healthy newborn are not an
eligible expense.
Condition/Type of Service/Expense
NICOTINE GUM OR PATCHES
OTC
NORPLANT INSERTION OR REMOVAL
Account
Type
HCFSA
HCFSA
NSAIDS
Eligible
Expense
Potentially
Eligible
Expense*
X
X
Additional Information
Examples: Nicoderm, Nicorette
See Birth Control
HCFSA
X
Examples: Advil, Alleve, Ibuprofen, Motrin, Naprosyn,
Naproxen
HCFSA
X
Wages, employment taxes, and other amounts you pay for
nursing services (including extra costs for nurses' room and
board) generally may qualify, whether provided in the
participant's home or another facility. The attendant doesn't
have to be a nurse, so long as the services are of a kind
generally performed by a nurse. These include services
directly related to caring for and monitoring your, your
spouse’s or dependent’s condition, including:
OTC
NURSING SERVICES PROVIDED BY A
NURSE OR OTHER ATTENDANT
(private duty nursing)
Not
Eligible
Preparing and giving medication;
Changing dressings and providing wound care;
Monitoring vital signs;
Assessing responses to prescribed treatments, and
documenting those assessments in written notes;
If the individual providing nursing services also provides
household and personal services, only those charges related
to actual nursing care are eligible expenses.
NUTRITIONAL SUPPLEMENTS
HCFSA
X
Dietary, nutritional, and herbal supplements, vitamins, and
natural medicines are not reimbursable if they are merely
beneficial for general health. However, they may be
reimbursable if recommended by a medical practitioner to
treat a specific medical condition.
HCFSA
X
Nutritional services related to the treatment and guidance of a
specific diagnosis or medical condition may be reimbursed.
OTC
NUTRITIONIST
O
OBSTETRICAL EXPENSES
HCFSA
X
OCCLUSAL GUARDS TO PREVENT
TEETH GRINDING
HCFSA
X
ONLINE OR TELEPHONE
CONSULTATION, MEDICAL
PRACTITIONER'S FEE FOR
HCFSA
x
OPTOMETRIST
HCFSA
X
ORTHODONTIA
HCFSA
X
HCFSA
X
ORTHOPEDIC SHOE INSERTS
Will qualify, so long as the consultation's purpose is to obtain
advice to treat or mitigate a medical condition.
May qualify if used to treat injured or weakened body parts.
OTC
ORTHOPEDIC SHOES
HCFSA
X
Won't qualify if used for personal or preventive reasons. If
used to treat or alleviate a specific medical condition, only the
excess cost of the specialized orthopedic shoe over the cost of
a regular shoe will qualify.
X
Must be used to treat a specific medical condition. Effective
January 1, 2011 OTC drugs and medicines must be
prescribed.
OTC
OSTEOPATH
HCFSA
OVER-THE-COUNTER MEDICINES AND
DRUGS
HCFSA
OTC
X
Condition/Type of Service/Expense
OVULATION MONITOR
OTC
OXYGEN
Account
Type
Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
HCFSA
X
See PREGNANCY TESTS
HCFSA
X
This includes the expenses of oxygen and oxygen equipment
for breathing problems caused by a medical condition.
P
PAIN RELIEVERS
OTC
HCFSA
X
Examples: Advil, Aspirin, Tylenol
PATTERNING EXERCISES
HCFSA
X
Expenses of hiring someone to give patterning exercises to a
mentally retarded child qualify. These exercises consist mainly
of coordinated physical manipulation of a child's arms and legs
to imitate crawling and other normal movements.
PENILE IMPLANTS
HCFSA
X
Amounts paid for implants may be eligible if the diagnosis of
impotence is due to organic causes, such as diabetes, postprostatectomy complications, or spinal cord injury.
PERSONAL TRAINER FEES
HCFSA
X
Only if these are incurred for a limited duration and a medical
practitioner has recommended a supervised exercise regiment
in order to treat a disease or injury (for example, rehab after
surgery or the treatment of obesity). The expense must not
have been incurred "but for" the disease (e.g., if you were
working with a personal trainer before being diagnosed, the
expense would not qualify).
PHYSICAL EXAMS
HCFSA
X
PLACEMENT SERVICES
DCFSA
X
The up-front fee may qualify if it is an expense that must be
paid in order to obtain care. However, the fee can only be
reimbursed proportionately over the duration of the
agreement to employ the dependent care provider.
HCFSA
X
Pregnancy tests, Ovulation kits
PREGNANCY TESTS
OTC
PRENATAL VITAMINS
HCFSA
X
PRESCRIPTION DRUGS
HCFSA
PRESCRIPTION DRUGS - IMPORTED
HCFSA
PREVENTIVE CARE SCREENINGS
HCFSA
X
PROSTHETICS
HCFSA
X
PSYCHIATRIC SERVICES AND CARE
HCFSA
X
PSYCHOANALYSIS
HCFSA
If taken during pregnancy (a medical condition) prenatal
vitamins may be considered primarily for medical care.
Vitamins taken at other times generally do not qualify.
X
Must be used to treat a medical condition and not for
personal, general health, or cosmetic purposes. Drugs that are
illegally procured do not qualify. Note: Dual purpose items
that include a medical and cosmetic purpose may require a
certification of medical necessity form.
X
IRS regulations state that any drug imported into the United
States by a consumer is not eligible for reimbursement under
an FSA.
If the tests are designed to assess symptoms of a medical
diagnosis, they may be eligible for reimbursement. Examples
include clinic and home testing kits for blood pressure,
glaucoma, cataracts, hearing, cholesterol, etc.
X
If the expense is for medical care, and not just for the general
improvement of mental health, relief of stress, or personal
enjoyment.
See COUNSELING
Condition/Type of Service/Expense
PSYCHOLOGIST
Account
Type
Eligible
Expense
HCFSA
Potentially
Eligible
Expense*
X
Not
Eligible
Additional Information
If the expense is for medical care, and not just for the general
improvement of mental health, relief of stress, etc.
See COUNSELING
R
RADIAL KERATOTOMY
READING GLASSES
HCFSA
X
HCFSA
X
Includes prescription sunglasses (even those purchased overthe-counter).
OTC
RETIN-A
HCFSA
X
If recommended by a medical practitioner for a specific
medical condition (e.g. acne vulgaris) and not for cosmetic
purposes.
HCFSA
X
If recommended by a medical practitioner for a specific
medical condition. The expenses must be to ameliorate a
deformity arising from congenital abnormality, personal injury
from accident or trauma, or disfiguring disease.
OTC
ROGAINE
OTC
S
SCREENING TESTS
HCFSA
X
If the tests are used for medical diagnoses.
SERVICE ANIMALS
HCFSA
X
See GUIDE DOGS; OTHER SERVICE ANIMALS
SHIPPING AND HANDLING
HCFSA
X
Shipping and handling fees to obtain an item that constitutes
medical care (example: mail-order prescription delivery fee)
would qualify.
SLEEPING AIDS
HCFSA
X
Examples: Unisom, Nytol, Sominex
HCFSA
X
Examples: Commit, Nicoderm CQ, Nicorette, Nicotrol
HCFSA
X
If recommended by a medical practitioner for a specific
medical condition (sleep apnea). Examples: Breathe Right,
Snorezz
SPECIAL EDUCATION AND SCHOOLS
HCFSA
X
See LEARNING DISABILITIES
SPECIAL FOODS
HCFSA
X
Special foods or beverages may qualify if prescribed by a
medical practitioner to treat a specific illness or ailment and if
the foods do not substitute for normal nutritional
requirements. The special food or beverage must be in
addition to normal nutritional requirements. The
amount that may qualify is limited to the amount by which the
cost of the special food exceeds the cost of commonly
available versions of the same product.
SMOKING CESSATION PROGRAMS
AND MEDICATIONS
OTC
OTC
See NICOTINE GUM OR PATCHES
SNORING CESSATION AIDS
OTC
Example # 1 – Not eligible
Special infant formula would not be eligible because it is a
substitute for food that is normally consumed by an individual
to satisfy nutritional requirements and is considered personal
expenses, not medical care expenses.
Example # 2 – May be eligible
Ensure High Protein Complete may be covered if extra protein
and extra nutrition is needed in your diet. Not to substitute
for food that is normally consumed or to satisfy nutritional
requirements.
SPEECH THERAPY
HCFSA
X
Condition/Type of Service/Expense
Account
Type
Eligible
Expense
Potentially
Eligible
Expense*
X
Not
Eligible
Additional Information
SPERM STORAGE
HCFSA
STERILIZATION PROCEDURES
HCFSA
X
STERILIZATION REVERSAL
HCFSA
X
STUDENT HEALTH FEE
HCFSA
SUBSTANCE ABUSE TREATMENT
HCFSA
X
See ALCOHOLISM
SUNGLASSES
HCFSA
X
If they are prescription sunglasses. (Not clip on sunglasses)
SUNBURN CREAMS AND OINTMENTS
OTC
SUNSCREEN
Fees for temporary storage may be reimbursed, but only to
the extent necessary for immediate conception.
X
HCFSA
X
Example: Solarcaine
HCFSA
X
Won't qualify if to maintain general health or for other
personal reasons. May qualify if used to treat or alleviate a
specific medical condition, and if the expense would not have
been incurred "but for" the condition.
OTC
SURROGATE EXPENSES
Only expenses for specific medical services would qualify.
HCFSA
X
HCFSA
X
T
TANNING SALON OR EQUIPMENT
HCFSA
TAXES ON MEDICAL SERVICES AND
PRODUCTS
HCFSA
X
X
No, if just to improve general health or appearance.
May be reimbursed under a HCFSA for treatment of certain
skin disorders, such as eczema and psoriasis. There must not
be any personal element or use of the equipment by other
family members.
Taxes on medical services and products may be reimbursed
under a HCFSA. This includes local, state, service and other
taxes.
HCFSA
X
Examples: Orajel, Anbesol
TEETH WHITENING
HCFSA
X
Not eligible if tooth discoloration is simply the result of aging
and the whitening is done for cosmetic purposes. But if tooth
discoloration was caused by disease, birth defect, or injury,
expenses for teeth whitening might qualify.
TELEPHONE FOR HEARING IMPAIRED
PERSONS
HCFSA
X
Expenses associated with purchasing or repairing special
telephone equipment for you, your spouse or dependent with
a hearing impairment may be eligible for reimbursement
under a HCFSA.
TELEVISION FOR HEARING-IMPAIRED
PERSONS
HCFSA
X
Expenses for equipment that displays the audio of television
programming as subtitles for hearing impaired persons are
eligible for reimbursement under a HCFSA.
TEETHING/TOOTHACHES
OTC
See: DENTAL CARE
The eligible expense is limited to the cost that exceeds the
cost of a non-adapted set.
See CAPITAL EXPENSES.
THERMOMETERS
OTC
HCFSA
THROAT LOZENGES
OTC
HCFSA
X
X
Examples: Cepacol, Chloraseptic
See COLD, FLU, DECONGESTANT & SINUS REMEDIES
Condition/Type of Service/Expense
TOILETRIES
Account
Type
Eligible
Expense
Potentially
Eligible
Expense*
HCFSA
Not
Eligible
X
OTC
Additional Information
Examples: Body Sprays, Cologne, Creams, Deodorants, Hair
Removal, Lipsticks, Lotion, Make-up, Perfumes, Shampoo,
Shaving Cream, Skin Moisturizers, Soaps, Toothbrush,
Toothpaste
See COSMETIC PRODUCTS
TOPICAL STEROIDS
OTC
HCFSA
X
Example: Hydrocortisone
TRANSPLANTS
HCFSA
X
Includes surgical, hospital, and laboratory services, and
transportation expenses for organ donors.
TRANSPORTATION EXPENSES FOR
PERSON TO RECEIVE MEDICAL CARE
HCFSA
X
If the expenses are primarily for and essential to medical care.
These include car expenses, bus, taxi, train, plane, and ferry
fares, and ambulance services. Parking fees and tolls may also
qualify. Instead of actual car expenses, a standard mileage
rate (23.5 cents per mile effective 1/1/14) for use of a car to
obtain medical care is allowed.
TRANSPORTATION OF SOMEONE
OTHER THAN THE PERSON RECEIVING
MEDICAL CARE
HCFSA
X
In some cases, transportation expenses of the following
persons may be reimbursed:
A parent who must go with a child who needs medical care;
A nurse or other person who can give injections, medications
or other treatment required by a patient traveling to get
medical care and who is unable to travel alone;
Visits to see your mentally ill dependent, if part of a treatment
plan.
TRIPS
HCFSA
X
TUITION EXPENSES OR FEES
DCFSA
X
Excursions taken for a change in environment, general health
improvement etc., even those taken on the advice of your
health care provider are not an eligible expense.
U
ULTRASOUND, PRE-NATAL
HCFSA
X
May qualify if used as a diagnostic tool to determine fetal
health and development. Won't qualify if for other purposes
such as to obtain prenatal snapshots.
UMBILICAL CORD, FREEZING AND
STORING OF
HCFSA
USUAL AND CUSTOMARY CHARGES,
EXCESS
HCFSA
X
VACCINES
HCFSA
X
VARICOSE VEINS, TREATMENT OF
HCFSA
VASECTOMY
HCFSA
X
See STERILIZATION PROCEDURES
VASECTOMY REVERSAL
HCFSA
X
See STERILIZATION REVERSAL
VENEERS
HCFSA
VETERINARY FEES
HCFSA
VIAGRA
HCFSA
X
Cialis and Levitra may also be reimbursed.
VISION CARE & CORRECTION
PROCEDURES
HCFSA
X
Medical procedures that correct vision, including laser
procedures such as Lasik and radial keratotomy.
VISION DISCOUNT PROGRAMS
HCFSA
X
Might qualify if there is a specific medical condition that the
umbilical cord is intended to treat.
Medical expenses in excess of your plan’s usual, customary
and reasonable charges may be reimbursed under a HCFSA if
the underlying expense is eligible.
V
X
May qualify if the procedure promotes the proper function of
the body or prevents or treats an illness or disease.
X
X
Veneers are used primarily for cosmetic purposes.
Will qualify if the veterinary fees are incurred for the care of a
guide dog or other animal used by a disabled person.
X
Fees paid to gain access to a vision network, or to a reduced
fee structure are not an eligible expense under a HCFSA.
See INSURANCE PREMIUMS
VITAMINS
HCFSA
OTC
X
Only if recommended by a medical practitioner for a specific
medical condition
Condition/Type of Service/Expense
Account
Type
Eligible
Expense
HCFSA
X
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
W
WALKERS
WART REMOVER TREATMENTS
OTC
HCFSA
X
Example: Compound W
WEIGHT LOSS PROGRAMS AND/OR
DRUGS PRESCRIBED TO INDUCE
WEIGHT LOSS
HCFSA
X
If the weight loss program is recommended by a physician to
treat an existing disease (such as obesity, heart disease, or
diabetes) and is not simply to improve general health.
WELL-BABY/WELL-CHILD CARE
HCFSA
X
HCFSA
X
X
The full cost of a wig purchased because the patient has lost
all of his or her hair from disease or treatment.
WHEELCHAIRS
OTC
OTC
WIG
HCFSA
OTC
2015 Plan Year
The products listed are examples, and do NOT constitute an endorsement or an exhaustive listing of eligible medical expenses.
Eligible expenses listed here are subject to change without notice.
Medical care expenses include amounts paid for the diagnosis, cure, treatment, or prevention of disease, and for
treatments affecting any part of or function of the body. The expenses must be to alleviate or prevent a physical
defect or illness and must be considered a deductible medical expense pursuant to IRS regulations.
SISC FLEX PLAN
P.O. Box 1808
Bakersfield, CA 93303-1808
(661) 636-4416 or 1-800-972-1727 ext. 4416
http://sisc.kern.org/flex/